Hospices Tackle Telehealth Challenges During COVID-19

The COVID-19 pandemic has hindered some of the hands-on patient care that hospices deliver. While some hospices were well-positioned to integrate and increase technology utilization into a wider scope of services, others have hit obstacles.

When the U.S. Centers for Medicare & Medicaid Services (CMS) announced temporary waivers on requirements last month, expanding the allowable use of telehealth services was among the flexibilities offered to hospice. The temporary waiver was intended to help support providers in delivering safe care and minimize infection risks to staff and patients during in-person visits. While telehealth keeps patients and families connected with their hospices, providers have had to develop and implement new processes and absorb the associated costs.

“We were fortunate that we were pretty well-equipped already to be able to do telehealth measures more so than others who haven’t done it,” said Carla Davis, CEO for South Carolina-based Heart of Hospice. “We already had technology in place and office staff was able to turn on a dime to work remotely. We immediately implemented telehealth even before the government announced flexibilities. All staff disciplines were trained, including nurse practitioner and physician visits, as telehealth was not something that we had done much of in the past, but we are doing it now.”

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Hospice care is now infused with technology, which has largely driven improvement, such as improved accuracy in patient records and availability of information for patients, families, and referral partners. Even with these improvements, the hospice industry overall is behind in utilizing technology in operations and administration, patient care and raising end-of-life care awareness, according to some experts.

“Hospices as a field are so progressive in so many ways, but technology isn’t usually one of them,” said Brian Mistler, chief operating officer for Resolution Care in California. “Most hospices and other health care systems are having to catch up really quickly. Hospices across the country are figuring out how to bring technology into homes for the people they serve and business operations to support their staff. There is still a steep learning curve for hospices that have resisted technology until now. Some seek technology, and others have technology thrust upon them. What we thought would take years has happened in weeks out of necessity.”

Among the concerns that come with increased telehealth is defining the parameters for when and how the hospice should use it. As the pandemic created an urgent and time-sensitive need for many critical patients, providers were met with the task of designing telehealth programs independently while awaiting more hospice-specific guidelines from federal agencies.

“Different markets are impacted in different ways,” Davis said. “And so [Heart of Hospice] defined when our practitioners and physicians should go to critical hospice patient visits only. We also defined this for some of our other markets that are still making visits. It’s become more normal than not because nothing’s normal today.”

As telehealth reorients patient care during the COVID-19 pandemic, hospices are increasingly concerned about the accompanying price tag. Software systems can be costly to acquire, set up and implement with staff training, as well as update and maintain over time. The upfront and immediate cost can place financial stress on organizations already pressed for resources.

Integrating the technology and educating staff on how to use it can be difficult, regardless of an organization’s size. While some online training courses are free and supported by grants to offset the costs, many nonprofit organizations have experienced diminished fundraising limiting their available cash flow.

Despite the obstacles, hospices stand to benefit from growing their tech capabilities. Advance care planning conversations have remained a priority during the pandemic, as the outbreak has put the need for end-of-life planning to the forefront of patients’ and families’ minds.

“Now is absolutely the time,” Davis said. “This is the right time to encourage those conversations because things are happening faster than [patients and families] might think. It’s always the right time to encourage it, but especially now. You can do advanced care planning conversations through telemedicine.”

Another benefit is the connective capacity technology brings. Relationships and connections are still thriving even with social distancing measures between providers, staff, volunteers, patients, families, referral partners and community resources.

“Telehealth is much more powerful now in so many ways,” Mistler told Hospice News. “Individuals can use video technology to connect in real time across the country with family and care providers. They can have people join them even as they near death that wouldn’t have otherwise been able to. Technology can also help connect hospices to the best referral sources, staffing, volunteers, and leadership in that telehealth requires a team trained in using the technology.”

Even with the benefits of technology, the shift of increased telehealth in the hospice space raises several questions. With CMS requirements only temporarily relaxed during the pandemic, the potential for lasting impacts on hospice rules is unknown as providers look ahead.

With more questions than answers, hospices have much ground to cover in expanding telehealth over time, and this will require some research, according to Mistler. Hospices don’t yet know how full or hybrid telehealth models might impact idea ratios of managers and support staff.

Leaders will have to identify the core competencies that managers will need to work in environments that involve heavy amounts of teleconferencing and distributed workforces, Mistler told Hospice News.

“We might hypothesize that fewer support staff and managers are needed when telehealth is increased, as there is greater caregiver access and less physical infrastructure and related liability or compliance to manage,” Mistler said. “Alternatively, it might be discovered that more administrative support is needed as a distributive workforce requiring additional management and technology support, and requires a smaller managerial span of control to maintain effectiveness absent physical presence.”

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